Virtual Endoscopy

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The number of required assistance in simulator group is more than that in control group, which could be explained by the fact that the control group where not real novices. Patient discomfort and performance assessment by the experts are two important aspects for evaluation of simulator training.

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Increased patient comfort was found from simulation training, demonstrating that computer-based endoscopy simulator training has a direct benefit to the patient [29]. However, it is difficult to compare simulator training with conventional training on patient discomfort and performance assessment for different points-scoring system used in different studies. A popular standardized points-scoring system is needed to establish.

Further research comparing computer-based simulator training with traditional teaching is needed. Simulator training method could not only used for basic manual skills, but also for therapeutic endoscopic skills. A single-blind, randomized, controlled trial compared the effect of knowledge-based teaching and simulator-based skills training in 4 therapeutic endoscopic procedure: control of nonvariceal upper GI bleeding, polypectomy, stricture dilation, and percutaneous endoscopic gastrostomy tube insertion.

Simulator training group significantly improved performance of polypectomy, control of upper GI bleeding, and esophageal dilation [31].

Twenty-eight fellows in New York and 36 in France were trained for manual skills, injection, coagulation, hemoclip application and variceal ligation with the compact EASIE simulator. Successful hemostasis was significantly improved in performance of participants [32]. In a prospective multicenter randomized controlled trial during early training, a significantly higher proportion of the biliary cannulations performed by trainees with endoscopic retrograde cholangiopancreatography ERCP mechanical simulator practice were successful and with faster cannulation time compared with those performed by trainees without such practice [33].

Further studies comparing computer-based simulator training with traditional teaching for therapeutic endoscopic skills are needed. Based on this systematic review, simulator training method has been shown to be effective for the training of beginners. To date the knowledge on the learning curves for residents, the endoscopy training curriculum, and the effects of tutor feedback on simulator training is very limited.

Studies demonstrated that psychomotor training had a significant effect on the learning curves of a simulated colonoscopy [34 35]. Residents and nurses showed similar learning curve patterns. There were not significant differences between the groups in terms of volume of insufflated air, percentage of time without discomfort, and percentage of mucosa seen [36].

Camera motion tracking of real endoscope by using virtual endoscopy system and texture information

The integrated GATE training improved both theoretical knowledge and manual skill of physicians [37]. A study demonstrated that in the absence of feedback, it is not possible to improve performance on the HT Immersion Medical Colonoscopy Simulator [38]. Above all, future studies are needed to assess different teaching methods for virtual simulator training. Although, rigorous inclusion criteria has been made to reduce the heterogeneity.

Several limitations of this systematic review should be noted. First, the presence of heterogeneity between studies is a concern. The included studies varied with respect to training schedule, training time, training procedure, type of simulator and teaching technique, which bring sources of heterogeneity [39]. Secondly, the systematic review relied on publications, not on individual patient data.


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At present, access to individual patient data is still very difficult, and a consensus should be reached that such data should be made available to address subsequent research questions. Thirdly, for colonoscopy training, novices in two studies Ahlberg , Sedlack had a formal gastroscopy training, which made it easier to learn colonoscopy. Additionally, the main source of bias comes from blinding of outcome assessment and allocation sequence concealment.

We did not detect publication bias between studies, for there were too few studies included in each comparison to produce a meaningful analysis. These limitations all affect results. In summary, the limited data available suggest that simulator training might be effective for gastroscopy, but so far no data is available to support this for colonoscopy.

Overall, the study population or trial size evaluated in studies of simulator training for endoscopy teaching is small. Well-designed randomized studies are needed to establish the optimal training curriculum for simulator method.


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The efficacy of combination of simulator training and bedside teaching could also be evaluated in future studies. We would like to thank Shengli An for his contributions to the discussion concerning the statistical analysis. We would also like to thank Haiyang Liang for assisting us with the expanded manual searching of foreign language articles and additional information.

Wrote the paper: WQ YB. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Advances in virtual endoscopy simulators have paralleled an interest in medical simulation for gastrointestinal endoscopy training.

Virtual Gastrointestinal Endoscopy

Objective The primary objective was to determine whether the virtual endoscopy simulator training could improve the performance of novices. Design A systematic review. Setting Randomized controlled trials RCTs that compared virtual endoscopy simulator training with bedside teaching or any other intervention for novices were collected. Patients Novice endoscopists. Main outcome measurements Independent procedure completion, total procedure time and required assistance. Limitations The included studies are quite in-homogeneous with respect to training schedule and procedure. Conclusions Virtual endoscopy simulator training might be effective for gastroscopy, but so far no data is available to support this for colonoscopy.

Funding: These authors have no support or funding to report. Introduction Gastrointestinal endoscopy, especially for gastroscopy and colonoscopy, is the basic skills required for gastroenterology fellows. Definition Virtual endoscopy simulator training was defined as that the novices received structure training schedule based on the virtual endoscopy simulator.

Study Selection To be eligible for inclusion in this systematic review, studies were required to meet the following criteria: 1 Randomized controlled trials RCTs ; 2 comparison between virtual endoscopy simulator training and bedside teaching any other intervention for novices were collected; 3 information on independent procedure completion, total procedure time or required assistance were provided; and 4 being published.

Data Extraction Two investigators Wendi Zhang and Yuqing Chen independently extracted the available data independent procedure completion, total procedure time and required assistance , with discrepancies resolved by consensus. Results Characteristics of Individual Studies A total of citations were identified after searching. Download: PPT. Figure 1. Flow diagram of study selection for the systematic review. Effects of Interventions Gastroscopy. Figure 4. Forest plot of comparison: procedure completed independently for gastroscopy.

Figure 5. Forest plot of comparison: total procedure time sec for gastroscopy. Figure 6. Forest plot of comparison: required assistance for gastroscopy. Figure 7. Forest plot of comparison: procedure completed independently for colonoscopy. Figure 8. Forest plot of comparison: total procedure time min for colonoscopy.

virtual endoscopy

Figure 9. Forest plot of comparison: required assistance for colonoscopy. Discussion The results of this systematic review suggest that virtual endoscopy simulator training is effective for novices in gastroscopy, but not in colonoscopy. Conclusions In summary, the limited data available suggest that simulator training might be effective for gastroscopy, but so far no data is available to support this for colonoscopy. Supporting Information. Table S1. Characteristics of the included studies.

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Gastroenterology —1; author reply 2.

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Clinical Outcomes Research Initiative. The American journal of gastroenterology — View Article Google Scholar 5. Techniques in Gastrointestinal Endoscopy — View Article Google Scholar 6. Gromski MA, Matthes K Simulation in advanced endoscopy: state of the art and the next generation. Techniques in Gastrointestinal Endoscopy —8. View Article Google Scholar 7. Cantu P, Penagini R Computer simulators: the present and near future of training in digestive endoscopy. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver — View Article Google Scholar 8.